What Works for Women and Girls

and women have unsafe abortions to terminate unplanned pregnancies. Of 1,357 withincomplete abortion, 708 admitted unsafe abortion. Women were offered HIV testingand counseling about contraception and HIV and, 407 (58%) accepted HIV testing.Prior to the study, condom use during the past six months before hospital admittancewas low, with 61% never using condoms. Among women who accepted being testedfor HIV, 73% accepted to use condoms either alone or in combination with hormonalcontraception after having been provided with contraceptive counseling. Of the 407women who accepted HIV testing, 14% were HIV-positive. “… Women who have anunsafe abortion comprise a vulnerable group who are at high risk of repeated unsafeabortion and HIV infection” (Rasch et al., 2006: 703). (Gray III) (HIV testing, abortion,condom use, health facilities, Tanzania)A study in South Africa found that providing HAART at primary care clinics withadequate support for health facilities resulted in a four-fold increase in new HAARTinitiations with a high rate of viral load suppression of over 85% and a twenty foldincrease in CD4 cell count testing in HIV-positive adults. Systems improvementsincluded immediate CD4 cell count determination if HIV test results are positive, withmultiple processes at the same visit, such as counseling, lab testing, clinic staging, etc.;nurses designated to follow-up on basis of CD4 cell counts; increased reliance on clinicaljudgment of health workers who know the clients well, such as deferring homevisits based on logistics; patients are referred back from secondary and tertiary HAARTinitiation sites to primary care clinics for care (Barker et al., 2007a). (Gray IV) (HAART,health facilities, HIV testing, South Africa)In the Western Cape Province of South Africa, all HIV-positive women identifiedthrough PMTCT services undergo immunologic testing. Pregnant women with CD4counts greater than 200 receive a two drug short course of zidovudine and nevirapinefor PMTCT, whereas those with CD4 counts of 200 or lower are immediately referredto separate HIV treatment facilities for a ‘fast-track’ evaluation and HAART initiation(Coetzee et al., 2005 cited in Abrams et al., 2007). Instituted in 2004 and nowimplemented on a wide scale, this has contributed to low rates of PMTCT, estimatedat between 6 to 8% (Abrams et al., 2007). (Gray V) (PMTCT, pregnancy, CD4 counts,HAART, health facilities, South Africa)Integrating HIV/AIDS treatment in 53 health facilities in 23 districts in Mozambiquewith 80,000 people resulted in 70% decline of loss to follow up from antenatal care toART services over one year (Pfeiffer et al., 2008). (Abstract) (treatment, antenatal care,health facilities, Mozambique)A study at a hospital in Kenya found that integration of PMTCT, ANC and MCH servicesreduced MTCT, increased women’s retention in HIV care and improved follow-upof infants born to HIV-positive women. Women who tested HIV-positive were givenHAART if appropriate. Prior to the integration project, women who tested HIV-positivedid not report to the HIV clinic even when personally escorted by hospital staff.WHAT WORKS FOR WOMEN AND GIRLS375